The Clinical Center first
appeared in PHS building plans in October 1944. Heading the 10-year PHS
prospectus for postwar construction were proposals for a 500-bed Medical
Center hospital and a 200-bed Neuropsychiatric Institute and hospital
on the Bethesda reservation.11
The 79th Congress was averse to President Franklin D. Roosevelts
domestic spending programs and preferred to locate postwar research authority
in a private body, which would contract clinical research to leading medical
schools and university centers.12
Temporarily blocked, Parran and NIH Director Rolla G. Dyer enlisted the
services of Mary E. Switzer, Parrans superior in the Federal Security
Agency, to write legislation authorizing the mental health clinical unit
as well as a nationwide hospital building program, which Congress readily
funded in August 1946.13
The administration froze public works spending before considering the
$18 million PHS proposal to start the Bethesda expansion, but Parran managed
to get the Bureau of the Budget to approve $2.6 million for land purchasing
and architectural services in December 1946. A building committee was
hastily set up within the PHS, and in January Parrans staff submitted
the first comprehensive plan for expanding the Bethesda reservation.14

Preparations for a dozen new
buildings began in earnest in April 1947, after Parran established a symbiotic
relationship with the new Republican chair of the House Appropriations
Subcommittee, Frank B. Keefe of Wisconsin. With only a promise of $22
million for construction expenses in 1948, an NIH research facilities
committee chaired by Norman Topping plunged ahead with a 30-line site
agenda projected to cost $116,246,765.15

The catalyst of this new,
full-speed-ahead political environment was extramural research. Requests
for research funding from medical schools, academic departments, and hospital
centers surged at the end of the war, but philanthropies and drug companies
proved unwilling to invest enough capital to sustain the research boom.
Moreover, the proposed National Science Foundation became mired in congressional
debates complicated by the insistence of leading academic scientists that
basic research be kept separate from agencies controlling research applications.
Keefe and other key members of Congress decided that spring that the study
sections and advisory councils Parran and Dyer had organized in 1945 and
1946 were the only effective instruments available to fund the wave of
emergent medical technology.16
In October, President Harry S Truman joined this consensus by accepting
the Steelman Committees recommendation that medical research spending
be tripled quickly. The upshot was a resolution by the Federal Bureau
of Hospitalization on November 4, 1947, authorizing construction of a
research hospital, together with ancillary structures, which
would combine mental health and chronic/infectious disease research.17

After a whirlwind of planning
activity between the NIH Directors Office and the Public Building
Service, Representative Keefe on March 5 accepted a special appropriation
request for $31,830,000 to construct the main building.18
The substructure contract was let in July, and in the fall steam shovels
excavated the hillock behind Top Cottage, creating a mountain of spoil
dirt, which dwarfed existing buildings. Behind the scenes the planning
focus slipped, reflecting the abrupt dismissal of Surgeon General Parran
in February and the need to accommodate within the organization two more
categorical institutes, Heart and Dental Research, which Congress chartered
at mid-year.19

Dr. Jack Masur, assistant
director at Montefiore Hospital and a specialist in chronic care administration,
was appointed director of the embryonic hospital staff on April 1, 1948.
One of 55 consulting specialists to the planning committee, Dr. Masur
used New Yorks Goldwater and Memorial Hospitals as institutional
models in designing the Clinical Center. His leadership of the later planning
phases diminished the importance of PHS traditions in both clinic and
laboratory. Impatient with the lack of training and professional development
in the Marine Hospital clinical service, which after 1944 was barred from
using patients for research,20
Masur set out to create new professional standards and to optimize patient
care in the emerging world of scientific medicine.